Association of Disability Compensation With Mortality and Hospitalizations Among Vietnam-Era Veterans With Diabetes
Authors: Amal N. Trivedi, Lan Jiang, Donald R. Miller, Shailender Swaminathan, Courtney A. Johnson, Wen-Chih Wu, Kyle Greenberg
Journal: JAMA Internal Medicine (2022)

<h3>Importance</h3> It remains poorly understood whether income assistance for adults with low income and disability improves health outcomes. <h3>Objective</h3> To examine the association between eligibility for disability compensation and mortality and hospitalizations among Vietnam-era veterans with diabetes. <h3>Design, Setting, and Participants</h3> Quasiexperimental cohort study of a July 1, 2001, policy that expanded eligibility for disability compensation to veterans with “boots on the ground” (BOG) during the Vietnam era on the basis of a diagnosis of diabetes; veterans who were “not on ground” (NOG) remained ineligible. Participants were Vietnam-era veterans with diabetes in the Veterans Affairs Healthcare System. Difference-in-differences were estimated during early (July 1, 2001-December 31, 2007), middle (January 1, 2008-December 31, 2012), and later (January 1, 2013-December 31, 2018) postpolicy periods. Data analysis was performed from October 1, 2020, to December 1, 2021. <h3>Exposures</h3> Interaction between having served with BOG (as recorded in Vietnam-era deployment records) and postpolicy period. <h3>Main Outcomes and Measures</h3> Primary outcomes were all-cause mortality and hospitalizations. <h3>Results</h3> The study population included 14 247 BOG veterans (mean [SD] age at baseline, 51.2 [3.8] years; 25.7% were Black; 3.3% were Hispanic; 63.6% were White; and 6.9% were of other race) and 56 224 NOG veterans (mean [SD] age, 54.2 [6.3] years; 21.7% were Black; 2.1% were Hispanic; 67.1% were White; and 8.2% were of other race). Compared with NOG veterans, BOG veterans received $8025, $14412, and $17 162 more in annual disability compensation during the early, middle, and later postpolicy periods, respectively. Annual mortality rates were unchanged (prepolicy mortality rates: 3.04% for BOG and 3.56% for NOG veterans), with adjusted difference-in-differences of 0.24 percentage points (95% CI, −0.08 to 0.52), −0.08% (95% CI, −0.40 to 0.24), and −0.08% (95% CI, −0.48 to 0.36), during the early, middle, and later postpolicy periods. Among 3623 BOG veterans and 19 174 NOG veterans with Medicare coverage in 1999, a population whose utilization could be completely observed in our data, BOG veterans experienced reductions of −7.52 hospitalizations per 100 person-years (95% CI, −13.12 to −1.92) during the early, −10.12 (95% CI, −17.28 to −3.00) in the middle, and −15.88 (95% CI, −24.00 to −7.76) in the later periods. These estimates represent relative declines of 10%, 13%, and 21%. Falsification tests of BOG and NOG veterans who were already receiving maximal disability compensation prior to the policy yielded null findings. <h3>Conclusions and Relevance</h3> In this cohort study, disability compensation among Vietnam-era veterans with diabetes was not associated with lower mortality but was associated with substantial declines in acute hospitalizations. Veterans’ disability compensation payments may have important health benefits.